The impact of culture and education on non-verbal neuropsychological measurements: a critical review

Clinical neuropsychology has frequently considered visuospatial and non-verbal tests to be culturally and educationally fair or at least fairer than verbal tests. This paper reviews the cross-cultural differences in performance on visuoperceptual and visuoconstructional ability tasks and analyzes the impact of education and culture on non-verbal neuropsychological measurements. This paper compares: (1) non-verbal test performance among groups with different educational levels, and the same cultural background (inter-education intra-culture comparison); (2) the test performance among groups with the same educational level and different cultural backgrounds (intra-education inter-culture comparisons). Several studies have demonstrated a strong association between educational level and performance on common non-verbal neuropsychological tests. When neuropsychological test performance in different cultural groups is compared, significant differences are evident. Performance on non-verbal tests such as copying figures, drawing maps or listening to tones can be significantly influenced by the individual's culture. Arguments against the use of some current neuropsychological non-verbal instruments, procedures, and norms in the assessment of diverse educational and cultural groups are discussed and possible solutions to this problem are presented.